TY - JOUR
T1 - Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair
T2 - a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery†
AU - Etz, Christian D
AU - Weigang, Ernst
AU - Hartert, Marc
AU - Lönn, Lars Birger
AU - Mestres, Carlos A
AU - Di Bartolomeo, Roberto
AU - Bachet, Jean E
AU - Carrel, Thierry P
AU - Grabenwöger, Martin
AU - Schepens, Marc A A M
AU - Czerny, Martin
N1 - © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Ischaemic spinal cord injury (SCI) remains the Achilles heel of open and endovascular descending thoracic and thoracoabdominal repair. Neurological outcomes have improved coincidentially with the introduction of neuroprotective measures. However, SCI (paraplegia and paraparesis) remains the most devastating complication. The aim of this position paper is to provide physicians with broad information regarding spinal cord blood supply, to share strategies for shortening intraprocedural spinal cord ischaemia and to increase spinal cord tolerance to transitory ischaemia through detection of ischaemia and augmentation of spinal cord blood perfusion. This study is meant to support physicians caring for patients in need of any kind of thoracic or thoracoabdominal aortic repair in decision-making algorithms in order to understand, prevent or reverse ischaemic SCI. Information has been extracted from focused publications available in the PubMed database, which are cohort studies, experimental research reports, case reports, reviews, short series and meta-analyses. Individual chapters of this position paper were assigned and after delivery harmonized by Christian D. Etz, Ernst Weigang and Martin Czerny. Consequently, further writing assignments were distributed within the group and delivered in August 2014. The final version was submitted to the EJCTS for review in September 2014.
AB - Ischaemic spinal cord injury (SCI) remains the Achilles heel of open and endovascular descending thoracic and thoracoabdominal repair. Neurological outcomes have improved coincidentially with the introduction of neuroprotective measures. However, SCI (paraplegia and paraparesis) remains the most devastating complication. The aim of this position paper is to provide physicians with broad information regarding spinal cord blood supply, to share strategies for shortening intraprocedural spinal cord ischaemia and to increase spinal cord tolerance to transitory ischaemia through detection of ischaemia and augmentation of spinal cord blood perfusion. This study is meant to support physicians caring for patients in need of any kind of thoracic or thoracoabdominal aortic repair in decision-making algorithms in order to understand, prevent or reverse ischaemic SCI. Information has been extracted from focused publications available in the PubMed database, which are cohort studies, experimental research reports, case reports, reviews, short series and meta-analyses. Individual chapters of this position paper were assigned and after delivery harmonized by Christian D. Etz, Ernst Weigang and Martin Czerny. Consequently, further writing assignments were distributed within the group and delivered in August 2014. The final version was submitted to the EJCTS for review in September 2014.
KW - Aorta, Abdominal
KW - Aorta, Thoracic
KW - Aortic Aneurysm, Thoracic
KW - Endovascular Procedures
KW - Europe
KW - Humans
KW - Intraoperative Neurophysiological Monitoring
KW - Practice Guidelines as Topic
KW - Spinal Cord
KW - Spinal Cord Ischemia
KW - Thoracic Surgical Procedures
U2 - 10.1093/ejcts/ezv142
DO - 10.1093/ejcts/ezv142
M3 - Journal article
C2 - 25991554
SN - 1010-7940
VL - 47
SP - 943
EP - 957
JO - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
IS - 6
ER -